Religion Not Always a Motivator for Doctors Who Care for Poor

TUESDAY July 31, 2007 -- Although providing aid and comfort to the less fortunate is a fundamental tenet of organized religion, a new U.S. survey suggests religious doctors are slightly less likely to care for poor and underserved patients than doctors who say they aren't religious.

As reported in the July/August issue of Annals of Family Medicine, 35 percent of doctors who described themselves as either atheist, agnostic, or without religious affiliation said they practiced medicine among the underserved, compared to 31 percent of religious physicians.

Study lead author Dr. Farr Curlin, an assistant professor of medicine with the MacLean Center for Clinical Medical Ethics at the University of Chicago, described the spread between the numbers as "slight, statistically speaking."

"However, the important point is that it doesn't seem to matter much what a physician's general religious characteristics are," he said. "They are more or less equally likely to care for the underserved."

The researchers found that, for many physicians, helping those most in need can be its own reward. The impulse is often rooted in deeply held values, whether religious or secular.

On the down side, doctors who decide to work with the poor, the uninsured and the underserved typically do so at a considerable cost in terms of salary, prestige, free time, administrative control, and academic opportunity, the researchers said.

To gauge the impact that faith might have on a doctor's decision to embark on the more self-sacrificing route, Curlin and his team analyzed questionnaires completed by 1,144 physicians from across the United States.

All the respondents were under age 65, and all were asked about their religious beliefs and whether or not they attended to underserved patients. "Underserved" patients included people who were uninsured, receiving Medicaid, or attending a so-called "safety-net setting" -- such as a free clinic, community or migrant health center, public or county hospital, or rural health center.

Slightly more than 25 percent of those doctors surveyed said they work among underserved patients. Those who did so tended to be slightly younger, female, and more likely to work in an academic setting.

Among types of doctors, 40 percent of psychiatrists said they work in an underserved environment -- the highest ratio observed. Only 21 percent of those performing medical sub-specialties indicated a similar choice -- the lowest ratio observed.

In terms of religious convictions, doctors who considered themselves to be "highly spiritual" -- but not necessarily affiliated with a religion -- were about twice as likely to attend to underserved patients than those indicating they were not so spiritual.

The researchers theorized that the connection between strong spirituality and attending to poor patients might be rooted in a liberal social justice tradition that, they said, informs much of today's mainstream and liberal Protestant churches.

Doctors who said they had no religious affiliation or who grew up in families that stressed service to the underprivileged were also among the most likely to care for the underserved.

"Everybody knows caring for the poor is a good thing," noted Curlin, who describes himself as an orthodox Protestant Christian. "Yet there are a lot of reasons to not care for the poor. A lot of selfish reasons. Because it's hard and it costs you. But what religious communities do with respect to those behaviors that are good, but are costly, is give people support and exhortation to live up to that calling, even though it's hard."

Dr. Peter Ubel, a professor in the department of medicine at the University of Michigan, applauded Curlin for conducting "a great study on a great topic."

"I think this hits at a fundamental question in medical practice," he said. "Which is: Are we here to do well by doing good? The nice thing about being a physician is that you're saving peoples lives, and making people feel better. Oh, and by the way, we're paid pretty well by doing it. So it almost becomes impossible to know what our primary motivation is anymore. Is it because I'm well reimbursed and respected as a status figure, or because I want to do good? And I expect most physicians can't figure it out."

"Now, you might expect it to be different for doctors who are religious," Ubel added. "But I would say that morality is not owned by religious people. In fact, many agnostics are driven by a strong sense of right and wrong. And so one thing that comes out of this study is to remind people of that fact. And it suggests that if you want to know if people have good intentions, don't ask them if they go to church on Sunday. Judge people by their actions, not by their congregation."

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